Search Results (27)

Objective: The aim of this study was to assess the effects of vestibular stimulation (semicircular canals/utricles) compared to cochlear stimulation on phantom pain and depersonalization/derealization symptoms after ≥3 months since traumatic amputation of hand-finger(s). Methods: A total of 125 adults (38.2 ± 8.1 years old) with phantom pain after amputation of one to four fingers agreed to participate. None of them wore prosthetic devices or had history of otology/audiology/vestibular/neurology/rheumatology/orthopedic/psychiatry disorders or psychopharmacological treatment. After a preliminary assessment, in a random order, they were exposed to caloric stimulation (right/left 44 °C/30 °C), centrifuge (right/left), and transient evoked otoacoustic emissions (TOAEs, right/left) with a follow-up of three days in between. Immediately before and after each stimulus, they reported on their pain characteristics and depersonalization/derealization symptoms. Results: After vestibular stimulation, a decrease in pain intensity was reported by at least one-third of the participants, which persisted for at least one day in the majority of them. Less than one-sixth of the participants reported pain decrease after cochlear stimulation. No influence was observed based on the side of the stimulation or the temperature, but the stimuli sequence had an effect. The centrifuge and TOAE effects were related to anxiety/depression symptoms and mainly observed when they were the first stimulus used. After caloric stimulation, pain decrease was independent from the sequence of the stimuli, and it was related to reports of feeling estrangement from the body. Conclusions: Mild caloric vestibular stimulation, whether applied to the right or left side and using warm or cold temperature, can modulate phantom pain after amputation of hand-finger(s) in patients with altered bodily sensations. However, individual cofactors may influence one’s susceptibility to experiencing this effect. Full article

Background/Objectives: Chronic stress has an undeniable effect in generating emotional disorders and physiological changes. It results in excessive muscle tension throughout the body, also in the masticatory system. A situation of chronic stress was the COVID-19 pandemic. The aim of this paper was to assess the prevalence of specific masticatory pain symptoms, their severity, and the co-occurrence of associated symptoms (otological symptoms and headaches) in patients diagnosed before and during the COVID-19 pandemic. Methods: A total of 202 patients were divided into two groups: Group A (mean age of 36.46; F = 64; and M = 37) and B (mean age of 26.04; F = 70; and M = 31) included patients who presented for the study before and after the COVID-19 pandemic, respectively. The Oral Behaviours Checklist (OBC) questionnaire was used: patients with result ≥2 scores in the OBC were evaluated by DC/TMD. To evaluate the intensity of pain in masticatory structures, the elements of the RDC-TMD questionnaire were used. Otologic symptoms and headaches were assessed as coexisted complaints. Results: A significant increase in pain occurrence was observed in Group B mainly for masseter muscles (p < 0.0001), temporalis (p = 0.0044), and medial pterygoid muscles (p = 0.0153). A significantly more frequent reporting of pain/tenderness was observed among men in most of the evaluated muscles. For the lateral pterygoid muscles, changes in palpation pain did not reach statistical significance. There was a statistically significant difference in the intensity of pain in the temporomandibular joint area between both the entire groups A and B (p = 0.000152), as well as between women in Group A and B (p = 0.006453) and men in the study groups (p = 0.007990). An increase in the incidence of headaches was observed among men in Group B (Group A with 40.6% vs. Group B with 67.3%). The most commonly reported otological symptom in both groups was ear pain and/or discomfort in the preauricular region, with the frequency of otological symptoms being higher in Group B. Conclusions: (1) The COVID-19 pandemic affected the incidence and severity of masticatory muscle pain and associated complaints. (2) A decrease in the age of patients reporting complaints of masticatory mm pain was observed during the COVID-19 pandemic. (3) An increase in the frequency of headaches was observed in the male group during the pan-demic, while in women there was an increase in palpation tenderness of masticatory muscles. Full article

Background/Objectives: Persistent and distressing tinnitus and TMDs may significantly impair the quality of patients’ lives. Problems are particularly severe for those who experience both. Although the exact causes of this association are not fully understood, several hypotheses connect TMD conditions with otological symptoms. Methods: The systematic review presented involved records published between 1 January 2004 and 27 November 2024, in the databases PubMed, Scopus, and Web of Science, according to the PRISMA guidelines. The search queries included “temporomandibular disorder” and “tinnitus”. Inclusion and exclusion criteria were predefined according to PECOS. A risk of bias assessment and meta-analyses were performed. The study’s protocol was registered in PROSPERO (CRD42024533293). Results: Eleven studies included in this review fulfilled all the predefined criteria. In a sample of 114,071 tinnitus patients, 50.99% (95% CI: 33.31–68.54) also had coexisting TMDs. Furthermore, tinnitus patients had more than 2.2 times higher odds of having TMDs compared to the control group (p = 0.002 for random effects). The absence of data regarding randomisation, blinding, and sample size justification was the most frequent risk of bias. Conclusions: Tinnitus frequently co-occurs in patients who suffer from TMDs. It is essential to expand the diagnostic evaluation of patients to confirm its presence and assess its impact on their quality of life. Additionally, dental consultation should be considered to evaluate patients about TMD signs and symptoms when suffering from tinnitus. Full article

Background: Hearing loss is a highly prevalent condition in the world population that determines emotional, social, and economic costs. In recent years, it has been definitely recognized that the lack of physiological binaural hearing causes alterations in the localization of sounds and reduced speech recognition in noise and reverberation. This study aims to explore the psycho-social profile of adult workers affected by single-sided deafness (SSD), without other major medical conditions and otological symptoms, through comparison to subjects with normal hearing. Methods: This is a cross-sectional, case-control study. Subjects aged between 24 and 65 years, all currently employed and affected by SSD, were enrolled. They were administered both disease-specific and psychometric tests, such as the Hearing Handicap Inventory for Adults (HHIA), the Profile Questionnaire for Rating Communicative Performance, the Psychological General Well-Being Index (PGWBI), and the Social Functioning Questionnaire (SFQ). Results: A total of 149 subjects (mean age = 49.9; SD ± 8.5) were enrolled in the period 2021–2023; 68 were males (45.6%), and 81 were females (54.4%). The normal hearing group was composed of 95 subjects, and the SSD sample was composed of 54 subjects. The results of our study show that the levels of psychological well-being and social functioning in subjects with SSD are statistically worse than in the group of subjects with normal hearing in most subscales. Conclusions: This study definitely outlined evidence for a significantly worse psychological health status and a poorer social attitude of working adults affected by SSD with respect to their normal-hearing counterparts. Understanding the impact of SSD on patients’ work environment suggests a multidisciplinary approach to such patients in order to increase their quality of life through adequate counseling, acceptance, and role modeling. Full article

This review focuses on the coexistence of tinnitus and temporomandibular disorders in terms of epidemiological data, etiology, differential diagnosis, treatment, and interaction between the two disorders. PubMed, Google Scholar, and ClinicalKey digital databases were used to search for publications covering the years 2009–2024. Finally, 77 publications were used. The review followed recommendations of the Scale for the Assessment of Narrative Review Articles. The prevalence of tinnitus in individuals with TMD amounted to 2–59% and was reported as the main concomitant symptom. Several studies reported that tinnitus was eight times more common in TMD sufferers. Among patients with tinnitus, TMJ disorders were observed at a frequency of 19%, while in the group presenting with a high severity of the condition, TMJ disorders were observed more frequently (36%). Based on this review, in order to facilitate the diagnosis and future treatment of tinnitus and TMD patients, a proposal for a multidisciplinary diagnostic algorithm is presented in the article. The cooperation of an otolaryngologist, audiologist, neurologist, psychiatrist, dentist, and physiotherapist may be considered in clinical settings. Full article

Background/Objectives: Multiple dehiscences of the otic capsule can exhibit behavior similar to Ménière’s disease, not only from a clinical perspective but also in the results of audiovestibular tests. The main objective of this study is to characterize third mobile window etiologies from an audiovestibular perspective, while also evaluating the therapeutic response to four different treatment protocols. Furthermore, we aim to explore a potential association with the development of radiologically defined endolymphatic hydrops (EH). Methods: This is a retrospective cohort study conducted from 2017 to 2024 at a tertiary-level otology and otoneurology unit. All patients underwent pure tone audiometry, vHIT, cVEMP, and oVEMP. Some of these patients, selected under rigorous inclusion criteria based on clinical and audiometric findings, were subjected to a 4-h delayed intravenous gadolinium-enhanced 3D-FLAIR MRI. Results: We obtained a sample of 86 patients, with a mean age of 52.2 ± 7.64 years: 62.76% were female (n = 54) and 37.21% were male (n = 32); 88.37% (n = 76) were diagnosed with superior semicircular canal dehiscence syndrome (SSCDS), while 11.62% (n = 10) had other forms of otic capsule dehiscence. The most common symptom observed was unsteadiness (44%). While surgery is the only curative treatment, other medical treatments, such as acetazolamide, also helped reduce symptoms such as autophony, falls, instability, and vertigo attacks, with a relative risk reduction (RRR) exceeding 75% (95% CI, p < 0.05). The results of the MRI in EH sequences indicate that 7.89% of the patients diagnosed with SSCDS also developed radiological EH, compared to 40.00% of the patients with other otic capsule dehiscences, a difference that was statistically significant (p = 0.0029. Conclusions: Otic capsule dehiscences are relatively unknown conditions that require clinical diagnosis. Although VEMP testing is useful, imaging studies are necessary to localize and characterize the defect, most commonly found in the superior semicircular canal. We should consider these dehiscences in cases where there is a suspicion of EH development. Further research, including in vivo neuroimaging studies using hydrops sequences, is required to better understand their relationship to potential Ménière’s disease. Full article

Objective: to identify advanced or “so-called inoperable” cases of tympanojugular paragangliomas (PGLs) and analyze how each case is surgically managed and followed afterward. Study Design: a retrospective case series study. Methods: Out of 262 type C and D TJPs and more than 10 cases of advanced or so-called inoperable cases, files of 6 patients with a diagnosis of advanced tympanojugular PGLs who were referred to an otology and skull-base center between 1996 and 2021 were reviewed to analyze management and surgical outcomes. The criteria for choosing these cases involve having one or more of the following features: (1) a large-sized tumor; (2) a single ipsilateral internal carotid artery (ICA); (3) involvement of the vertebral artery; (4) a considerable involvement of the ICA; (5) an extension to the clivus, foramen magnum, and cavernous sinus; (6) large intradural involvement (IDE); and (7) bilateral or multiple PGLs. Results: The age range at presentation was 25–43 years old, with a mean of 40.5 years: two females and four males. The presenting symptoms were glossal atrophy, hearing loss, pulsatile tinnitus, dysphonia, shoulder weakness, and diplopia. The modified Infratemporal Fossa Approach (ITFA) with a transcondylar–transtubercular extension is the principal approach in most cases, with additional approaches being used accordingly. Conclusions: The contemporary introduction of carotid artery stenting with the direct and indirect embolization of PGLs has made it possible to operate on many cases, which was otherwise considered impossible to treat surgically. Generally, the key is to stage the removal of the tumor in multiple stages during the management of complex PGLs to decrease surgical morbidities. A crucial aspect is to centralize the treatment of PGLs in referral centers with experienced surgeons who are trained to plan the stages and manage possible surgical complications. Full article

Background: No studies to date have compared audiologic characteristics in patients with continuous and intermittent tinnitus. The present study classified tinnitus patients into continuous and intermittent groups based on tinnitus duration and compared their audiologic characteristics. Methods: This study enrolled 604 patients with tinnitus from January 2019 to December 2022. Clinical manifestations, PTA results, the frequency and loudness of tinnitus, ABR, DPOAE, and TEOAE tests were compared in patients with continuous and intermittent tinnitus. Results: Of the 604 patients, 231 (38.2%) had continuous and 373 (61.8%) had intermittent tinnitus. There were no significant between-group differences in otologic symptoms, tinnitus onomatopoeia. PTA showed that hearing thresholds, except at 125 Hz, were significantly higher in patients with continuous rather than intermittent tinnitus. The loudness of tinnitus was significantly greater in patients with continuous rather than intermittent tinnitus. ABR tests showed that the absolute latency of wave V was significantly longer in continuous than in intermittent tinnitus. Signal-to-noise ratios on TEOAE tests were significantly lower in patients with continuous rather than intermittent tinnitus at all frequencies tested (1, 1.5, 2, 3, and 4 kHz). Response rates to sound stimuli at all frequencies, except for 1 kHz, were significantly lower on DPOAE tests in patients with continuous rather than intermittent tinnitus. Conclusions: Continuous tinnitus is more common in males, more persistent over time, and is associated with a higher rate of hearing loss. In contrast, intermittent tinnitus is more common in women, appears acutely, and is associated with a relatively lower rate of hearing loss. Based on the findings of the current paper, it seems that audiologic characteristics may differ between patients with continuous and intermittent tinnitus. Full article

Objectives: The purpose of this study was to investigate the hearing characteristics and causes of sudden sensorineural hearing loss (SSNHL) in patients aged from 15 to 40 years, focusing on audiological outcomes one year after the diagnosis. Methods: The medical records of individuals with SSNHL who were referred to our tertiary-level audiologic center were reviewed. All patients had undergone comprehensive diagnostic evaluations, including high-resolution 3D-FLAIR delayed magnetic resonance imaging (MRI), cone beam computed tomography (CBCT), and screening for coagulation, infectious, and autoimmune diseases. Results: Overall, 56 patients (mean age 28.1 ± 7.6 years) were included in the study. The hearing threshold in the affected ear improved significantly from 56.0 ± 18.0 dB at the diagnosis to 46.9 ± 22.3 dB after one year (p = 0.02). The degree of hearing loss, audiometric configurations, hearing improvements, and adherence to hearing treatments showed considerable variability among patients. Aural fullness, tinnitus, and hyperacusis were the predominant symptoms associated with SSNHL, and their prevalence decreased significantly over time. The diagnostic protocol led to the identification of the specific cause of SSNHL in 75% (42/56) of patients. The known etiology was found to be otological (39.3%), infectious (21.4%), autoimmune (7.1%), vascular (5.4%), or neoplastic (1.8%). In particular, Menière’s disease (n = 12), isolated cochlear endolymphatic hydrops (n = 6), HSV-1 (n = 5), and EBV (n = 4) infections were the most frequent causes of SSNHL. Conclusions: The identification of the specific etiology of SSNHL may facilitate a more personalized approach to management and treatment. Full article

Ramsay Hunt syndrome (RHS) has a poor prognosis because of varicella-zoster virus (VZV) infection. This is most closely related to severe inflammation in the geniculate ganglion of the facial nerve due to VZV infection or reactivation. This study investigated whether there were differences in the prognosis and accompanying symptoms of facial paralysis based on the presence or absence of VZV IgM and IgG antibodies. This study was conducted as a retrospective chart analysis of 105 patients with RHS who were admitted to our hospital between 2015 and 2021. The House–Brackmann (HB) grade and electroneurography (ENoG) was used to evaluate the degree of facial paralysis. Patients’ subjective symptoms were evaluated by dividing them into dizziness, tinnitus, hyperacusis, and hearing loss. No difference was observed in the initial HB grade with or without IgM; however, the final HB grade was significantly higher in IgM-positive patients than in IgM-negative patients (p < 0.05). Further, when IgM was positive, the value of the orbicularis oculi muscle in the ENoG test results was significantly higher (p < 0.05), and symptoms of tinnitus and hyperacusis occurred more frequently (p < 0.05). The initial and final HB grades were significantly higher in IgG-positive patients than in IgG-negative patients (p < 0.05). When IgG was positive, the values of nasalis and oris muscles in the ENoG test results were significantly higher (p < 0.05), and symptoms of dizziness occurred more frequently (p < 0.05). This study confirmed that the more active the immunological action of the VZV in the body, the greater the damage to the facial and vestibulocochlear nerves, which are associated with the degree of facial paralysis and the accompanying otologic symptoms. Full article

This study intends to investigate the relationship between otologic symptoms, in particular, tinnitus, and temporomandibular disorders (TMD). The literature studies during the previous 20 years had focused on the treatment and alleviation of the otologic symptoms and were limited to randomized clinical trials, case reports, and prospective studies. The following Boolean keywords, (tinnitus) AND (temporomandibular disorders OR temporomandibular therapy), were used in the databases of PubMed, Scopus, and Web of Science between 2003 and 9 May 2023 with an English language restriction. Results: The computerized search turned up 693 articles in total, and after eliminating duplicates, reviewing them, and determining their eligibility, 20 papers were included. Conclusion: The connections between temporomandibular TMD and tinnitus are numerous and intricate. It is unclear whether TMD could be the source of tinnitus or only its symptoms. Tinnitus may not always occur in persons with TMD, indicating that additional causes may potentially be involved in its occurrence. The precise mechanisms behind the link between TMD and tinnitus need to be clarified by additional study. Full article

Temporomandibular disorders (TMDs) refers to different clinical conditions affecting the temporomandibular joints, masticatory muscles, and adjacent structures. Although TMDs signs and symptoms (e.g., pain and limited mouth opening) are common, otological symptoms, such as tinnitus, might also be present. This study aims to summarize the evidence of the effectiveness of physical therapy interventions in individuals with TMDs associated with tinnitus. Randomized controlled trials investigating the effectiveness of physical therapy in individuals of both genders aged 18 or older with TMDs associated with tinnitus were included. The electronic search was performed in the following databases: MEDLINE, EMBASE, CINAHL, PEDro and CENTRAL. A total of four studies were included. All studies showed that physical therapy reduced the intensity of tinnitus, and two trials showed a decrease in the pain intensity caused by TMDs, an increase in the pressure pain thresholds in the masticatory muscles and an improvement of mandibular function. Two studies presented a low risk of bias. Despite a low certainty of the evidence, this review showed that physical therapy reduces the intensity or severity of tinnitus associated with TMDs. Results may support future research on the topic and evidence-based practice by recommending the best physical therapy approach for patients, clinicians, researchers, and health system managers. Full article

Motorist’s vestibular disorientation syndrome (MVDS) is a disorder in which patients experience dizziness while driving. MVDS is under-reported in the literature, and in clinical practice, it often goes unrecognized. We identified clinical characteristics of patients with MVDS using data from 24 patients who faced difficulties while driving and were diagnosed with MVDS. Their symptoms, duration of illness, precipitating factors, co-morbidities, history of other neuro-otological disorders, severity of symptoms, and associated anxiety and depression were reviewed. Ocular motor movements were recorded using video-nystagmography. Patients with vestibular disorders that can cause similar symptoms while driving were excluded. The mean age of the patients was 45.7 ± 8.7 years, and most were professional drivers (90.5%). The duration of the illness ranged from eight days to ten years. Most patients presented with disorientation (79.2%) exclusively while driving. The most common triggers for symptoms were higher speeds, i.e., >80 km/h (66.7%), multi-lane roads (58.3%), bends and turns (50%), and looking at other vehicles or signals while driving (41.7%). A history of migraines was reported in 62.5% of the patients, and motion sickness was reported in 50% of the patients. Anxiety was reported in 34.3% of patients, and 15.7% had depression. The video-nystagmography did not show any specific abnormalities. Patients responded to drugs used in prophylactic treatments for migraines such as Amitriptyline, Venlafaxine, Bisoprolol, and Magnesium, and to Pregabalin and Gabapentin. Based on these findings, a classification system and a diagnostic criterion for MVDS were proposed. Full article

We report the case of a 51-year-old woman with multiple otologic and vestibular symptoms. She presented with two different types of tinnitus in her right ear, vertigo, and fluctuating aural symptoms in the left ear. She also complained of disequilibrium; chronic headache; hyperhidrosis; amenorrhea; insomnia; broadened hands and feet; and widened, thickened, and stubby fingers. The patient underwent careful collection of medical history, otomiscroscopy, pure tone audiometry, tympanometry, reflex threshold measurements, vestibular assessments, blood tests, magnetic resonance imaging (MRI), and cone beam computed tomography (CBTC) of the head. The audiogram showed: (1) a mild low-to-mid frequency conductive hearing loss, and a sharply sloping sensorineural hearing loss above 4000 Hz in the right ear; (2) a mild low-frequency sensorineural hearing loss in the left ear. MRI with 3D FLAIR sequences detected an acoustic neuroma (7.4 mm × 5.2 mm) in the middle-third of the right internal auditory canal, a pituitary macroadenoma (13 mm × 10 mm × 10 mm) and left saccular hydrops. The CBCT scan documented an outbreak of otosclerosis (3 mm) around the fissula ante fenestram in the right ear. Therefore, acoustic neuroma (right ear), growth hormone-secreting macroadenoma of the pituitary gland, Menière’s disease (left ear), and otosclerosis (right ear) were diagnosed/strongly suspected. A watch-and-wait strategy was adopted for acoustic neuroma and otosclerosis, while transsphenoidal surgery was successfully performed to remove the pituitary macroadenoma. This case report confirms that multiple otologic disorders can occur simultaneously in the same patient, requiring prompt audiological and imaging evaluations. Full article

Meniere’s disease (MD) is one of the most complicated diseases in the otologic clinic. The complexity of MD is partially due to the multifactorial etiological mechanisms and the heterogenous symptoms, including episodic vertigo, hearing loss, aural fullness and tinnitus. As a result, the diagnosis of MD and differentiating MD from other diseases with similar symptoms, such as vestibular migraine (VM), is challenging. In addition, it is difficult to predict the progression of hearing loss and the frequency of vertigo attacks. Detailed studies have revealed that functional markers, such as pure tone audiometry (PTA), electrocochleography (ECochG), vestibular evoked myogenic potential (VEMP), caloric test, video head impulse test (vHIT) and magnetic resonance imaging (MRI) could help to evaluate MD with different hearing levels and frequency of vertigo attacks. Investigations of molecular markers such as autoimmunity, inflammation, protein signatures, vasopressin and circadian clock genes in MD are still underway. This review will summarize these functional and molecular markers, address how these markers are associated with hearing loss and vertigo attacks in MD, and analyze the results of the markers between MD and VM. Full article